Hysterectomy

Hysterectomy

A hysterectomy is the removal of the uterus. A total hysterectomy removes the entire uterus and cervix, while a partial hysterectomy means just the upper part of the uterus is removed. The surgery is usually done to address uterine fibroids, endometriosis, uterine prolapse, cancers, and other uterine problems. The procedure takes from one to three hours, and it takes about four to six weeks to recuperate.

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What is a hysterectomy?

A hysterectomy is the surgical removal of the uterus. There are many medical conditions that are addressed by a hysterectomy, from pelvic pain and bleeding to cancers. There are different types of hysterectomies and several different surgical procedures for performing them, including some minimally-invasive techniques.

Hysterectomy is a common surgery, second only to Cesarean section. You can’t carry a pregnancy after a hysterectomy, so women sometimes wait (if possible) until they’ve completed their families before having the surgery.

Why do women get hysterectomies?

Uterine fibroids (noncancerous growths on the walls of the uterus) are the most common reason women get hysterectomies. But there are many other conditions hysterectomies are used to treat, including:

  • Endometriosis (an overgrowth of tissue in the lining of the uterus)
  • Uterine prolapse (when the uterus drops down into the vagina)
  • Abnormal vaginal bleeding
  • Chronic pelvic pain or severe pain with menstrual cycles
  • Gynecologic cancer, such as cervical, ovarian, or uterine cancer
  • Abnormalities, such as hyperplasia (an increase in the number of cells), that may lead to cancer
  • Adenomyosis (a thickening of the uterus as tissue grows into the walls of the uterus)

Are there different types of hysterectomies?

Yes, there are three types of hysterectomies.

Total hysterectomy

The entire uterus and cervix are removed. This is the most common type of hysterectomy.

Partial hysterectomy

Also called a subtotal or supracervical hysterectomy, this is the removal of the upper part of the uterus. The cervix is not removed.

Radical hysterectomy

The uterus, cervix, tissue on both sides of the cervix, and the upper part of the vagina are removed. A radical hysterectomy may be done if you have or are suspected to have cancer. Sometimes a surgeon won’t know until they’re doing the surgery whether surrounding structures need to be removed. And sometimes they’re removed as a preventative measure (to prevent cancer, for example).

Most of the time, the fallopian tubes are removed along with the uterus. In some instances (because cancer is suspected, for example), one or both ovaries are removed as well. Both ovaries aren’t routinely removed however, because removing them will cause early menopause.

Removing the ovaries is called oophorectomy, and removing the fallopian tubes is called salpingectomy. Surgery that removes the uterus, both Fallopian tubes, and both ovaries is called a hysterectomy and bilateral salpingectomy-oophorectomy.

Hysterectomy techniques

The technique your surgeon recommends will depend on why the surgery is being done as well as other factors – such as the size and shape of your vagina and uterus, how accessible your uterus is (because of pelvic adhesions, for example), how advanced your condition is, whether or not other procedures will be done at the same time, and surgeon preference. Sometimes the surgeon will change techniques after the surgery starts and they’re able to better see exactly what needs to be done. The goal is to maximize benefits and minimize risks of the surgery.

Abdominal hysterectomy

If you have an abdominal hysterectomy, your uterus is removed through an incision in your lower abdomen. The incision is six- to eight-inches long and made from your belly button to your pubic bone or across the top of your pubic hairline. Stiches or staples are used to close the incision.

The benefits of an abdominal hysterectomy are that it can be performed even if you have adhesions or a large uterus. This method also gives the surgeon a good view of your pelvic organs. It does have a higher risk of complications (such as infection, bleeding, blood clots, and nerve and tissue damage) than other hysterectomy techniques, however. And it takes longer to recover from an abdominal hysterectomy than a laparoscopic or vaginal hysterectomy. An abdominal hysterectomy is considered major surgery and usually requires a longer hospital stay.

Laparoscopic hysterectomy

Laparoscopic hysterectomy is done through small incisions in your abdomen. It’s considered a minimally invasive surgery. The surgeon inserts a laparoscope (a thin, lighted telescope) to examine your pelvic organs. Then your uterus is removed in small pieces through these incisions, through a larger incision in your abdomen, or through your vagina. If it’s removed through your vagina, it’s called a laparoscopic vaginal hysterectomy. You may go home the same day or the next day.

A laparoscopic hysterectomy takes longer than abdominal or vaginal surgery. And there’s increased risk of injury to the urinary tract and other organs. But laparoscopic technique has a lower risk of infection, results in less pain after the procedure, and requires a shorter hospital stay.

Robotic hysterectomy

A robotic hysterectomy is a type of minimally invasive laparoscopic hysterectomy. It’s performed by highly specialized gynecologic surgeons with a robot assistant. It can allow for more precision and higher magnification than traditional laparoscopy.

Vaginal hysterectomy

A vaginal hysterectomy is another type of minimally invasive hysterectomy. The uterus is removed through the vagina, with no abdominal incision. (There’s an internal incision, at the top of your vagina. Dissolvable stitches are used.) This method has the least complications and usually a shorter healing time than other methods. You may even go home the same day as the procedure.

If you have scar tissue or a very large uterus, a vaginal hysterectomy may not be an option for you.

When can you get a hysterectomy?

Because you’ll be unable to carry a pregnancy after a hysterectomy, if possible, you’ll want to postpone the surgery until after you’re finished with pregnancies. A hysterectomy is not reversible.

That said, hysterectomy is sometimes needed immediately – if you have uterine or ovarian cancer or if your uterus is hemorrhaging and can’t otherwise be stopped, for example.

You may also decide to get a hysterectomy to improve the quality of your life, and finding other ways (there are many!) to grow your family if desired. (See below.)

Is a hysterectomy ever used to stop postpartum bleeding?

Yes, in the case of postpartum hemorrhage, a hysterectomy may be done to stop the bleeding. But this is rarely necessary. (Your chances of needing one are higher if you have placenta previa or placenta accreta, or if you’ve had a previous c-section.)

There are other options for controlling postpartum bleeding. These include medication, stitches to repair tears, and a procedure called dilation and curettage (D&C) to remove the remaining placenta. Or a small balloon may be placed in your uterus, creating pressure against your uterine walls to compress blood vessels and encourage blood clotting.

It can be a life-saving measure but – because it results in the woman no longer being able to become pregnant – a hysterectomy is considered a last resort to stop postpartum bleeding.

What to expect during a hysterectomy

Your healthcare provider will prepare you for surgery by explaining the procedure and adjusting your medications, if necessary, beforehand. (If you’re taking blood thinners, such as aspirin or heparin, for example, you’ll probably need to stop taking them temporarily.)

You’ll have complete blood work done. You may also have a Pap test, an endometrial biopsy (to detect endometrial cancer or abnormal cells in the uterus), and a pelvic ultrasound, to examine the size of any fibroids, cysts, or polyps you may have.

You’ll have an IV for fluids and medications and a urinary catheter will be placed to collect your urine.

Depending on the type of procedure you’re having, you may be given general anesthesia (you’ll be asleep and a breathing tube will be placed) or regional anesthesia (through an epidural, and you’ll be awake through the procedure).

The procedure usually takes from one to three hours. How long it takes depends on the method being used for the surgery, the size of your uterus, what else is being removed, and any scarring you may have. After surgery, your doctor will close any incisions with staples, stitches, surgical glue, or steri-strips.

Hysterectomy side effects

After your hysterectomy, you’ll have both temporary and permanent side effects.

You may temporarily have:

  • Pelvic and abdominal pain. You’ll be given pain medication to use for a few days, until the pain subsides.
  • Redness, bruising, and swelling at the incision site for about a month if you had an abdominal hysterectomy.
  • Numbness around the abdominal incision for a couple of months
  • Vaginal bleeding and discharge for up to six weeks. You’ll use sanitary pads, not tampons.
  • Gas and bloating for a few days (up to several weeks). A warm compress and gentle exercise may help.
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  • Problems emptying your bladder

You may also be feeling emotional about your hysterectomy, depending on how you feel about no longer being able to have children. Or you may be elated to be symptom free, if you’ve been suffering. It’s normal to have both feelings, whether separately or at the same time.

Permanent changes:

  • You’ll no longer have menstrual periods after a hysterectomy. (Sometimes women who receive a subtotal hysterectomy continue to have a light period for a year because small amounts of the endometrial lining can remain.)
  • Menopause. Ovaries aren’t commonly removed during a hysterectomy, but if both are removed, you’ll experience menopause and may have strong symptoms – such as hot flashes, vaginal dryness, sleep problems, and mood swings – right away. Talk with your provider about hormone replacement therapy to help with symptoms. If your ovaries weren’t removed, they may still make estrogen, but you may go into menopause a couple of years earlier than the average age of 52. Note: Because removing both ovaries (eliminating estrogen production) may put you at higher risk for bone loss, heart disease, and other conditions, doctors sometimes now recommend leaving one fallopian tube and one ovary, to allow your body to continue to make estrogen and delay the onset of an early menopause.
  • Change in sexual feelings. Your sex life may improve, thanks to relief from pain and/or heavy vaginal bleeding. But if you’re having symptoms of menopause, you may have less interest in sex. Vaginal dryness may happen especially if your ovaries were removed. (A water-based lubricant or topical estrogen can help. Talk with your healthcare provider.)

Hysterectomy is considered a very safe surgical procedure. As with any surgery, though, there are possible complications (see below). 

What is the recovery process like after a hysterectomy?

Depending on the type of procedure you had, you’ll need to stay in the hospital for up to a few days after your hysterectomy. (Sometimes women go home the same day, other times – with a radical hysterectomy done for cancer, for example – women stay more than a couple of days.)

It typically takes four to six weeks to recover from abdominal surgery and three to four weeks to recover from vaginal or laparoscopic surgery. Your doctor will give you guidelines to follow for your recovery. They’re likely to include:

  • Walk as soon as possible after surgery. After you get home, take short walks, increasing the distance each day. Moving will help prevent blood clots. (You may also be given medication to help prevent blood clots.)
  • Get plenty of rest.
  • Don’t lift objects over 10 pounds for at least four to six weeks.
  • Don’t put anything into your vagina for four to six weeks.
  • Don’t have intercourse for six weeks.
  • You can take a shower, but don’t take a bath. Wash the incision with soap and water. Surgical strips will fall off on their own within a week, and stitches will dissolve in about six weeks. Staples will need to be removed by your healthcare provider.
  • Wait to drive for few days if you’ve had vaginal or laparoscopic surgery and about two weeks after abdominal surgery, as long as you’re no longer taking pain narcotics.
  • Wait four to six weeks to exercise.
  • Stay home from work for three to six weeks, depending on your job and how well you’re healing.

Contact your doctor right away if you have any of the following warning signs of problems after your surgery:

  • Fever over 100 degrees F
  • Bleeding or swelling at the incision site, opening of the incision
  • Bright red vaginal bleeding
  • Increasing pain or pain that doesn’t improve with pain medication
  • Difficulty urinating or having a bowel movement, or frequent urination
  • Nausea, vomiting, abdominal pain, diarrhea
  • Persistent, severe pain that doesn’t respond to pain killers
  • Pain during intercourse (after the six weeks have passed)
  • Coughing up blood
  • Shortness of breath or trouble breathing
  • No bowel movement for 3 days or longer

Can you get pregnant after a hysterectomy?

You cannot carry a pregnancy after a hysterectomy. It’s possible – though rare – to get pregnant after a hysterectomy if you have a cervix. But it’s not possible to carry the pregnancy because there’s no uterus to house the baby.

If you did get pregnant, the fertilized egg would implant someplace else, most likely in a fallopian tube, resulting in an ectopic pregnancy. Ectopic pregnancy after hysterectomy is pretty rare, but it’s a medical emergency, potentially causing a rupture and life-threatening hemorrhaging.

If you want to grow your family after having a hysterectomy, you have some options. You may want to consider adoption or a surrogate implantation. You can use your eggs for the implantation (harvested before your hysterectomy or – if your ovaries aren’t removed – afterwards). Or your male partner can provide sperm for the surrogate pregnancy, using a donor egg or the surrogate’s egg. And if you have a female partner, she can carry a pregnancy using her egg.

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